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RECEIVED <br /> r a <br /> err SAN JOAQUIN COUNTY <br /> t Y; ENVIRONMENTAL HEALTH DEPARTMENT JUN 0 2 2014 Return this form by the <br /> 600 East Main Street, Stockton, CA 95202-3029 12"'of each month <br /> •�; Telephone: 209 468-3420 Fax: 209 464-0138 Web:www.s v. aI����"" <br /> ._j p ( ) ( ) J9�NQfIr�UNnnENTAL HEAL'T <br /> y�c_-• ''� <br /> &SJEPTAG CLEA R'S REPORT PERMIPSERVICES <br /> Company Name: C /� c%�lC Repo or the m th of: yea <br /> Company Address: l (03� Signatur . <br /> Street Address City Zp Code <br /> All information submitted must be complete, accurate, and legible <br /> GALLONS (R) RESIDENTIAL NAME OF TREATMENT <br /> DATE NAME OF BUSINESS OR ADDRESS WHERE WORK WAS DONE (G) GREASE TRAP <br /> PUMPED PROPERTY OWNER FACILITY <br /> PLEASE INCLUDE STREET 0, DIRECTION, STREET NAME AND CITY PUMPED C CHEMICAL <br /> Cit <br /> city <br /> Cit <br /> Cil <br /> V / <br /> Ci <br /> Cit <br /> Citv <br /> Cit <br /> Cit <br /> citv <br /> city <br /> Cit <br /> Cit <br /> Cit <br /> Cit <br /> Citv <br /> Cit <br /> city <br /> SEPTAGE CLEANERS REPORT <br /> EHD 42-04 <br /> 10/4/07 <br />